Provider Demographics
NPI:1235447806
Name:MALLETT, JOHN THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
Last Name:MALLETT
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8617 LARUE GREEN CAMP RD E
Mailing Address - Street 2:
Mailing Address - City:LA RUE
Mailing Address - State:OH
Mailing Address - Zip Code:43332-9287
Mailing Address - Country:US
Mailing Address - Phone:803-530-5278
Mailing Address - Fax:
Practice Address - Street 1:1355 N LEXINGTON SPRINGMILL RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1126
Practice Address - Country:US
Practice Address - Phone:419-747-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03135435183500000X
SC13134183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist